Provider Demographics
NPI:1982671186
Name:JETHVA, NATWARLAL (MD)
Entity Type:Individual
Prefix:
First Name:NATWARLAL
Middle Name:
Last Name:JETHVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:18660 BAGLEY ROAD
Practice Address - Street 2:SUITE 102 A
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-239-1972
Practice Address - Fax:440-239-8105
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047059J207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0119204OtherGROUP MEDICAID
D368301OtherGROUP IND DIAGNOSTICS MED
F47159OtherSUMMACARE APEX
3610861OtherGROUP ASC MEDICARE
1780634279OtherGROUP NPI
102565OtherKAISER
000000202033OtherANTHEM
OH0511968Medicaid
11389457OtherCAQH
9273172OtherGROUP MEDICARE
0636990OtherAETNA
341783789037OtherCARESOURCE
CA4511OtherRR MEDICARE GROUP
341783789037OtherCARESOURCE
F47159OtherSUMMACARE APEX